5.1 Positioning Principles
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![]() It's fundamental!The mother provides the position. The baby does the latching (attaching). |
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Mother's position
Observation of experienced mothers will reveal that they adopt a myriad of positions for breastfeeding throughout the day, even walking. A breastfeed may last from a few minutes up to an hour. And the mother will repeat this many times a day for at least a year. Your guidance to her is simply to adopt a position that will avoid muscle strain and in which she is comfortable.
Lying positions are comfortable and facilitate rest while feeding and are particularly helpful with a newborn baby when the mother is still recovering from the birth experience.
Once the mother's dexterity and confidence increase most breastfeeds will probably occur sitting.
Baby's position
The infant's position refers to two underlying factors:
- the infant's position in relation to his mother eg. baby is lying horizontally/obliquely and mother is sitting vertically, mother and baby are both side lying on bed.
- the infant's own body position eg. straight back (not curved), head aligned with spine (not turned to side), slightly extended head (not flexed), prone or lateral.
From birth until about 3 to 4 months of age a baby's feeding behaviour is instinctive and reflexive. All actions should facilitate the baby's innate abilities rather than mother (or you) controlling the baby.
When he is correctly positioned he will have control of his head and neck. In this position he is able to easily accommodate a suck/swallow/breathe sequence for several minutes at a time without distress when the milk flow is rapid.
Principles of positioning
- Sensory input: Babies depend on smell and skin-to-skin contact to initiate their feeding behaviour. To elicit baby's instincts it is essential to stimulate these two senses.
Skin-to-skin contact (ie baby and mother unrestricted by clothing from the waist up) is best in the early days or when experiencing any latching difficulties. Baby needs firm chest-to-chest contact against the mother's body to allow him to orientate and focus. Chest-to-chest contact will calm the baby and initiate his seeking behaviours. If the baby is clothed remove bulky outer clothing and blankets.
The unwashed breast has a unique and individual odour that stimulates prefeeding activity and delays crying in the baby.1 Only if necessary a drop of milk may be expressed and wiped over the mother's nipple and areola (the infant can smell his mother very easily so don't waste time doing this when the baby is frantically seeking to latch).- Positional stability: Positional stability is necessary for the baby to control his head movements. There are three aspects to this stability...
Proximal stability: infant's head and neck in alignment and supported, and
Midline symmetry: ie. the muscles on either side of the spine are experiencing equal movement.
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![]() | ![]() Workbook Activity 5.2Complete Activity 5.2 in your workbook. | ![]() |
When sensory input and positional stability are achieved the baby will automatically move into the "Instinctive Position". This position is described by Glover (2004)2 as the baby tilting his head back and leading with his jaw and mouth to the breast where his mouth opens wide, tongue down and over bottom gum line ready to take the breast into his mouth.
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![]() | ![]() Applying the principles to practiceInstruct the mother to hold her baby
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For infants affected by prematurity, illness, a difficult birth, dysfunctional or poor muscle tone, positional turns, to name a few, this positioning is crucial to support and strengthen what functions and abilities they do have. Stabilized in this position, each feed has the potential to become a dynamic learning and exercise session for the infant to strengthen and coordinate muscle movement on both sides of the body.
By teaching all mothers and babies this essential positioning I believe you are "treating" all sorts of "normal" anomalies before they have a chance to become a problem. When you see this transform an apparently difficult breastfeeding problem it is pure magic to behold. The simplicity will astound you." (Glover, 2004 p89-90)2
Biological nurturing feeding position
This is achieved when the mother is laid back in a semi-reclined position. The infant lies prone on top of his mother's chest. The combination of these two body positions will release the most primitive neonatal reflexes (PNR) for pre-feeding responses.
Colson (2008)3 describes this as the biological nurturing position. Twenty PNRs for pre-feeding have been identified. Colson's research found that mother and baby pairs who practice full biological nurturing positions released 15.9 PNR compared to only 11.6 PNR in the partial or non-biological nurturing pairs. Biological nurturing posture maximises the baby's sensory input and maintains positional stability as a result of the prone body position of the baby acting as a gravity pull towards the mother. The infant is able to use his hands to knead the breast, his feet to push off his mother's abdomen and thrust himself toward the breast, he will lift his head up into extension to allow his chin to push forward into the breast and prepare for latch.
All of the principles of position are achieved naturally using the mother's body and gravity to stabilize the infant on her. This is a natural position for a mother to assume after birth - semi-reclining with her baby on her chest (it is also an enforced position following a cesarean section). We now know that it is this position in particular which is the stimulus for baby self-attachment, ie. innate responses.
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![]() | ![]() Start at the beginningDo you see some mothers who are struggling with breastfeeding - they feel awkward and unsure how to hold the baby; maybe the baby's responses seem confused?
Rather than rush in with an intervention, suggest that the mother lie back slightly and bring her baby onto her chest. Encourage her to talk to him and hold his back, being ready for him to "bob" his head towards her breast. She can assist to free his arms or support his head if he needs guidance. No interference, maximum opportunity for baby and mother to perform at their best! (This is best in skin-to-skin for a newborn, however, it can be very successful for the older baby who has becomes confused and is also effective when infant clothed, but not restricted by blankets.) | ![]() |
The principles are exactly the same for ALL positions

Laid back encourages prefeeding behaviour.
© B.Ingle IBCLC

Laid back position.
© B.Ingle IBCLC

Laid back position:well-latched.
© B.Ingle IBCLC

Cradle hold.
© D.Fisher, IBCLC

Side lying.
© D.Fisher, IBCLC

Cross cradle hold.
© D.Fisher, IBCLC

Underarm hold.
© D.Fisher, IBCLC
Closely examine each of the photographs above noting:
- Is there adequate sensory input? chest to chest and baby held firmly against mother's body?
- Is base stabilised? check for support across back and between shoulder blades
- Is there proximal stability? neck and head supported NB** NEVER hold the back of the baby's head at any time during positioning, latching and feeding
- Is there midline symmetry? baby's head and neck aligned with his spine; one arm on either side of breast
- Is chin firmly applied to breast, nose free to breathe?
- Is mother relaxed and well supported?
- Is mother's arm supporting baby held comfortably, with relaxed wrist and fingers?
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![]() | ![]() When the baby's head is held....The infant cranium is very sensitive. Pressure on the back of the head (by mother or 'helper') will cause:
Overzealous or misplaced hands can create a struggle or fight with the breast between the mother and baby. Be mindful of this and ensure that all the principles of positioning are always applied. | ![]() |
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![]() | The Principles of Positioning | ![]() |
The well-latched baby
When baby is well positioned he will assume the instinctive position:
- lifts head up,
- brings chin and mouth forward to make contact with the breast and nipple,
- initiating seeking behaviour.
The baby's chin should have first contact with the breast, with the bottom lip placement about 3 - 4cm (1-1.5 inches) from the nipple (about the edge of the 'average-sized' areola). This light touch will stimulate the rooting reflex if baby is not already exhibiting this seeking behaviour. The rooting reflex causes the baby's mouth to open wide, mouth directed to source of stimulation. The tongue comes down and forward to grasp the breast tissue into the mouth.
The firm pressure maintained by the mother on baby's back ensures baby is close to her body allowing him to achieve a wide, deep latch to the breast.
Some mothers need to, or prefer to, shape the breast slightly. If this is needed, simply applying some pressure near to the base of the nipple to create an indent on the side where the infant's nose is pointing, causes the nipple to tilt up at the nose. As the bottom lip is firmly planted at about the edge of the areola well under the nipple, the finger (or thumb) doing the tilting can then fold the nipple so it just brushes under baby's top lip. Refer to photograph below.
Hey presto - one beautifully latched baby, with breast tissue entirely filling his mouth!
This is an asymmetric latch: the mouth will NOT be centred over the nipple.

Note the baby is positioned below the nipple, coming up to it in the 'instinctive position' with head slightly extended, mouth wide, and tongue down and extended over the lower gum. Mother has shaped breast and tilted nipple towards baby's nose.
© Australian Breastfeeding Association
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![]() | ![]() Workbook Activity 5.3Complete Activity 5.3 in your workbook. | ![]() |
What should I remember?
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Self-test Quiz
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Click and drag the missing words below into their correct place The missing words are: above alignment areola bottom chin lip odour pre-feeding prone raise reflexive shoulders smell turned The principles of positioning can be applied to any breastfeeding situation. The mother may adopt a variety of body positions to hold her baby. The baby's body position is designated by the relationship of his body to his mother's body and the lie of his body in relation to the ground.To assist the mother and baby to achieve successful breastfeeding, you will need an understanding of all the factors which facilitate the best circumstances:
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Notes
- # Doucet S et al. (2007) The "smellscape" of mother's breast: effects of odor masking and selective unmasking on neonatal arousal, oral, and visual responses.
- # Glover R (July 14-18 2004) Lessons from Innate Feeding Abilities Transforms Breastfeed Outcomes
- # Colson S et al. (2008) Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.